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Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?

1

Get theFacts

2

CompareOptions

3

YourFeelings

4

YourDecision

5

QuizYourself

6

Your Summary

Get the facts

Your options

Take daily aspirin.

Don't take daily aspirin.

Is this decision for you? This could be a decision for you if you have NOT had a heart attack or a stroke. Aspirin is strongly recommended for people who have been diagnosed with heart disease or who have had a heart attack or some kinds of strokes.

Key points to remember

Aspirin lowers the chance of having a heart attack. The benefit is greatest for people at high risk of a heart attack. It is not clear that aspirin can help prevent a stroke.

You can work with your doctor to find out your risk of heart attack. Your risk is based on your cholesterol levels, blood pressure, age, sex, and other things, including whether you smoke.

Taking aspirin isn't right for everyone, because it can cause serious bleeding. You and your doctor can decide if aspirin is a good choice for you based on your risk of heart attack and your risk of serious bleeding.

If you have a high risk for a heart attack, you may decide that the benefits of aspirin outweigh the chance of serious bleeding.

If you have a low risk of a heart attack, the benefits of aspirin probably won't outweigh the risk of bleeding.

Even if you take aspirin every day, you can do other things to reduce your chance of having a heart attack. They include eating healthy foods, getting regular exercise, staying at a healthy weight, and not smoking. You also need to manage other health problems that increase your risk, such as diabetes, high blood pressure, and high cholesterol.

Your doctor can estimate your risk for a heart attack in the next 10 years. Your doctor may use a tool called a risk calculator to figure out your risk. The tools are not perfect. They may show that your risk is higher or lower than it really is. But they can give you and your doctor a good idea about your risk.

There are different calculators, but they all include details about your health. They include whether you:

Have high cholesterol.

Have high blood pressure.

Have diabetes.

Are male.

Are African-American.

Are older.

Smoke.

The more of these factors you have, the higher your risk of a heart attack.

If you have a low risk of heart attack, the benefits of taking aspirin probably won't outweigh the chance of serious bleeding.

If you have a high risk of heart attack, you may decide that the benefits of aspirin outweigh the chance of serious bleeding.

A heart attack occurs when a blood clot forms in one of the blood vessels that supply the heart muscle. Aspirin can prevent blood clots from forming in your arteries. This may help prevent a heart attack.

When you take aspirin, your blood clots more slowly. This increases your chance of bleeding problems, which can be serious.

Aspirin can cause your stomach or another part of your digestive tract to bleed. Rarely, aspirin causes bleeding in other parts of the body, including the brain.

The risk of bleeding isn't the same for everyone. Your doctor can help you know your risk of bleeding based on your age and your health. For example, people's risk of bleeding gets higher as they get older.

Some people have other problems from aspirin. These include an allergic reaction, stomach pain, and nausea.

Without aspirin, about 20 out of 100 people will have serious bleeding. This means that about 80 out of 100 won't.

With aspirin, about 31 out of 100 people will have serious bleeding. This means that about 69 out of 100 won't.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.footnote 1

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

People who have certain health problems shouldn't take aspirin. These include people who:

Have recently had a stomach ulcer or bleeding in the digestive tract.

Have recently had a stroke caused by bleeding in the brain.

Are allergic to aspirin.

Have asthma that is made worse by aspirin.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Take daily aspirin Take daily aspirin

You take aspirin as your doctor recommends. Most people take it every day.

You have a heart-healthy lifestyle. This includes being active, eating healthy foods, staying at a healthy weight, and not smoking.

Aspirin lowers the chance of a heart attack. The benefit is greatest for people at high risk of a heart attack.

It is not clear that aspirin can help prevent a stroke.

Aspirin increases the risk of serious bleeding.

Aspirin can cause side effects and other problems, such as an allergic reaction.

Don't take daily aspirin Don't take daily aspirin

You have a heart-healthy lifestyle such as being active, eating healthy foods, staying at a healthy weight, and not smoking.

You avoid the problems of aspirin, such as serious bleeding.

You avoid the bother and cost of taking aspirin every day.

Healthy habits alone will not lower your chance of a heart attack as much as healthy habits plus taking aspirin would. That's especially true for people with a high risk of heart attack.

Personal stories about taking daily aspirin to prevent a heart attack

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I've got high blood pressure. And my father died of a heart attack. Based on my risks, I decided it would be a good idea if I took a baby aspirin every day. My doctor agreed. It's no big deal. I take it at night when I go to bed.

Paul, age 63

I've got diabetes. My doctor explained my risk and showed me that aspirin would be helpful for me because people with diabetes have a higher risk of a heart attack. My blood sugar is under pretty good control. But I want to do everything I can to stay healthy, so I'm taking an aspirin every morning.

Graciela, age 61

I'm taking medicine for high cholesterol and high blood pressure. I wondered if I should be taking aspirin too, but my doctor said it could increase the risk of bleeding. I've had stomach ulcers off and on over the years, so aspirin would not be a good choice for me. I'll just keep my weight down and keep taking my cholesterol and blood pressure medicines.

Cal, age 48

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take daily aspirin

Reasons not to take daily aspirin

I'm willing to take pills every day to help prevent a heart attack.

I don't like taking pills.

More important

Equally important

More important

I am more worried about having a heart attack than the risk of serious bleeding problems.

I am more worried about the problem of serious bleeding than my risk of a heart attack.

More important

Equally important

More important

I want to do everything I can to lower my chance of having a heart attack.

I think I'm doing enough to lower my chance of having a heart attack.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking daily aspirin

NOT taking daily aspirin

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, I will get the most benefit from taking an aspirin if I have a higher risk of a heart attack.

TrueThat's right. Aspirin lowers the chance of having a heart attack. The benefit is greatest for people at higher risk of a heart attack. Your risk of a heart attack is based on your cholesterol levels, your blood pressure, whether you smoke, and other things.

FalseThat's not right. Aspirin lowers the chance of having a heart attack. The benefit is greatest for people at high risk of a heart attack. Your risk of a heart attack is based on your cholesterol levels, your blood pressure, whether you smoke, and other things.

I'm not sureIt may help to go back and read "Get the Facts." Aspirin lowers the chance of having a heart attack. The benefit is greatest for people at high risk of a heart attack. Your risk of a heart attack is based on your cholesterol levels, your blood pressure, whether you smoke, and other things.

2.2, If I have certain health problems, I may not be able to take aspirin.

TrueThat's right. If you are allergic to aspirin, have a stomach ulcer, or recently had a stroke caused by bleeding in the brain, you shouldn't take aspirin.

FalseSorry, that's not right. If you are allergic to aspirin, have a stomach ulcer, or recently had a stroke caused by bleeding in the brain, you shouldn't take aspirin.

I'm not sureIt may help to go back and read "Get the Facts." You shouldn't take aspirin if you are allergic to aspirin, have a stomach ulcer, or recently had a stroke caused by bleeding in the brain.

3.3, I don't have to worry about any side effects from taking aspirin every day.

TrueSorry, that's not right. Aspirin can cause side effects such as bleeding. Sometimes the bleeding can be serious.

FalseThat's right. Aspirin can cause side effects such as bleeding. Sometimes the bleeding can be serious.

I'm not sureIt may help to go back and read "Get the Facts." Aspirin can cause side effects such as bleeding. Sometimes the bleeding can be serious.

4.4, If I take a daily aspirin, it's not as important for me to follow a heart-healthy lifestyle.

TrueThat's not right. Even if you take aspirin every day, you can do other things to reduce your chance of having a heart attack. They include eating healthy foods, getting regular exercise, staying at a healthy weight, and not smoking. You also need to manage other health problems, such as diabetes, high blood pressure, and high cholesterol.

FalseThat's right. Even if you take aspirin every day, you can do other things to reduce your chance of having a heart attack. They include eating healthy foods, getting regular exercise, staying at a healthy weight, and not smoking. You also need to manage other health problems, such as diabetes, high blood pressure, and high cholesterol.

I'm not sureIt may help to go back and read "Get the Facts." Even if you take aspirin every day, you can do other things to reduce your chance of having a heart attack. They include eating healthy foods, getting regular exercise, staying at a healthy weight, and not smoking. You also need to manage other health problems, such as diabetes, high blood pressure, and high cholesterol.

Pignone M, et al. (2010). Aspirin for primary prevention of cardiovascular events in people with diabetes: A position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation, 121(24): 2694–2701.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Take daily aspirin.

Don't take daily aspirin.

Is this decision for you? This could be a decision for you if you have NOT had a heart attack or a stroke. Aspirin is strongly recommended for people who have been diagnosed with heart disease or who have had a heart attack or some kinds of strokes.

Key points to remember

Aspirin lowers the chance of having a heart attack. The benefit is greatest for people at high risk of a heart attack. It is not clear that aspirin can help prevent a stroke.

You can work with your doctor to find out your risk of heart attack. Your risk is based on your cholesterol levels, blood pressure, age, sex, and other things, including whether you smoke.

Taking aspirin isn't right for everyone, because it can cause serious bleeding. You and your doctor can decide if aspirin is a good choice for you based on your risk of heart attack and your risk of serious bleeding.

If you have a high risk for a heart attack, you may decide that the benefits of aspirin outweigh the chance of serious bleeding.

If you have a low risk of a heart attack, the benefits of aspirin probably won't outweigh the risk of bleeding.

Even if you take aspirin every day, you can do other things to reduce your chance of having a heart attack. They include eating healthy foods, getting regular exercise, staying at a healthy weight, and not smoking. You also need to manage other health problems that increase your risk, such as diabetes, high blood pressure, and high cholesterol.

FAQs

How can you know your risk for a heart attack?

Your doctor can estimate your risk for a heart attack in the next 10 years. Your doctor may use a tool called a risk calculator to figure out your risk. The tools are not perfect. They may show that your risk is higher or lower than it really is. But they can give you and your doctor a good idea about your risk.

There are different calculators, but they all include details about your health. They include whether you:

Have high cholesterol.

Have high blood pressure.

Have diabetes.

Are male.

Are African-American.

Are older.

Smoke.

The more of these factors you have, the higher your risk of a heart attack.

If you have a low risk of heart attack, the benefits of taking aspirin probably won't outweigh the chance of serious bleeding.

If you have a high risk of heart attack, you may decide that the benefits of aspirin outweigh the chance of serious bleeding.

What lifestyle changes can lower your chance of heart attack?

Even if you take aspirin, you can do other things to reduce your chance of having a heart attack.

Eat healthy foods.

Get regular exercise.

Stay at a healthy weight. Lose weight if you need to.

Don't smoke.

Manage other health problems, such as diabetes, high blood pressure, and high cholesterol.

How might aspirin prevent a heart attack?

A heart attack occurs when a blood clot forms in one of the blood vessels that supply the heart muscle. Aspirin can prevent blood clots from forming in your arteries. This may help prevent a heart attack.

Can aspirin prevent a stroke?

It is not clear that aspirin can help prevent a stroke.1 Some experts recommend that certain women take aspirin to help prevent a stroke, depending on their age and other things.1

What are the risks of taking aspirin?

When you take aspirin, your blood clots more slowly. This increases your chance of bleeding problems, which can be serious.

Aspirin can cause your stomach or another part of your digestive tract to bleed. Rarely, aspirin causes bleeding in other parts of the body, including the brain.

The risk of bleeding isn't the same for everyone. Your doctor can help you know your risk of bleeding based on your age and your health. For example, people's risk of bleeding gets higher as they get older.

Some people have other problems from aspirin. These include an allergic reaction, stomach pain, and nausea.

Without aspirin, about 20 out of 100 people will have serious bleeding. This means that about 80 out of 100 won't.

With aspirin, about 31 out of 100 people will have serious bleeding. This means that about 69 out of 100 won't.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Who can't take daily aspirin?

People who have certain health problems shouldn't take aspirin. These include people who:

Have recently had a stomach ulcer or bleeding in the digestive tract.

Have recently had a stroke caused by bleeding in the brain.

Are allergic to aspirin.

Have asthma that is made worse by aspirin.

2. Compare your options

Take daily aspirin

Don't take daily aspirin

What is usually involved?

You take aspirin as your doctor recommends. Most people take it every day.

You have a heart-healthy lifestyle. This includes being active, eating healthy foods, staying at a healthy weight, and not smoking.

You have a heart-healthy lifestyle such as being active, eating healthy foods, staying at a healthy weight, and not smoking.

What are the benefits?

Aspirin lowers the chance of a heart attack. The benefit is greatest for people at high risk of a heart attack.

It is not clear that aspirin can help prevent a stroke.

You avoid the problems of aspirin, such as serious bleeding.

You avoid the bother and cost of taking aspirin every day.

What are the risks and side effects?

Aspirin increases the risk of serious bleeding.

Aspirin can cause side effects and other problems, such as an allergic reaction.

Healthy habits alone will not lower your chance of a heart attack as much as healthy habits plus taking aspirin would. That's especially true for people with a high risk of heart attack.

Personal stories

Personal stories about taking daily aspirin to prevent a heart attack

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I've got high blood pressure. And my father died of a heart attack. Based on my risks, I decided it would be a good idea if I took a baby aspirin every day. My doctor agreed. It's no big deal. I take it at night when I go to bed."

— Paul, age 63

"I read about aspirin and how it can prevent a heart attack, so I talked with my doctor about it. After looking at the numbers, I could see that my risk of having a heart attack was really low. My blood pressure and cholesterol are all good, and I have a pretty healthy lifestyle. But we'll keep an eye on everything, and if it looks like my chances for a heart attack are going up, I can think about taking aspirin then."

Yvonne, age 52

"I've got diabetes. My doctor explained my risk and showed me that aspirin would be helpful for me because people with diabetes have a higher risk of a heart attack. My blood sugar is under pretty good control. But I want to do everything I can to stay healthy, so I'm taking an aspirin every morning."

— Graciela, age 61

"I'm taking medicine for high cholesterol and high blood pressure. I wondered if I should be taking aspirin too, but my doctor said it could increase the risk of bleeding. I've had stomach ulcers off and on over the years, so aspirin would not be a good choice for me. I'll just keep my weight down and keep taking my cholesterol and blood pressure medicines."

— Cal, age 48

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take daily aspirin

Reasons not to take daily aspirin

I'm willing to take pills every day to help prevent a heart attack.

I don't like taking pills.

More important

Equally important

More important

I am more worried about having a heart attack than the risk of serious bleeding problems.

I am more worried about the problem of serious bleeding than my risk of a heart attack.

More important

Equally important

More important

I want to do everything I can to lower my chance of having a heart attack.

I think I'm doing enough to lower my chance of having a heart attack.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking daily aspirin

NOT taking daily aspirin

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
I will get the most benefit from taking an aspirin if I have a higher risk of a heart attack.

True

False

I'm not sure

That's right. Aspirin lowers the chance of having a heart attack. The benefit is greatest for people at higher risk of a heart attack. Your risk of a heart attack is based on your cholesterol levels, your blood pressure, whether you smoke, and other things.

2.
If I have certain health problems, I may not be able to take aspirin.

True

False

I'm not sure

That's right. If you are allergic to aspirin, have a stomach ulcer, or recently had a stroke caused by bleeding in the brain, you shouldn't take aspirin.

3.
I don't have to worry about any side effects from taking aspirin every day.

True

False

I'm not sure

That's right. Aspirin can cause side effects such as bleeding. Sometimes the bleeding can be serious.

4.
If I take a daily aspirin, it's not as important for me to follow a heart-healthy lifestyle.

True

False

I'm not sure

That's right. Even if you take aspirin every day, you can do other things to reduce your chance of having a heart attack. They include eating healthy foods, getting regular exercise, staying at a healthy weight, and not smoking. You also need to manage other health problems, such as diabetes, high blood pressure, and high cholesterol.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Pignone M, et al. (2010). Aspirin for primary prevention of cardiovascular events in people with diabetes: A position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation, 121(24): 2694–2701.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

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